APMA News - March/April 2020 - 17

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Quality ID #126 (NQF 0417): Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy
- Neurological Evaluation
- National Quality Strategy Domain: Effective Clinical Care
- Meaningful Measure Area: Preventive Care
2020 COLLECTION TYPE:
MIPS CLINICAL QUALITY MEASURES (CQMS)

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MEASURE TYPE:
Process

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INSTRUCTIONS:
This measure is to be submitted a minimum of once per performance period for patients with diabetes mellitus
seen during the performance period. Evaluation of neurological status in patients with diabetes to assign risk
category and therefore have appropriate foot and ankle care to prevent ulcerations and infections ultimately reduces
the number and severity of amputations that occur. Risk categorization and follow up treatment plan should be done
according to the following table:

DESCRIPTION:
Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who had a neurological
examination of their lower extremities within 12 months

Table 1 - Risk Categorization System
Category
Risk Profile
Evaluation Frequency
0
Normal
Annual
1
Peripheral Neuropathy (LOPS)
Semi-annual
2
Neuropathy, deformity, and/or PAD
Quarterly
3
Previous ulcer or amputation
Monthly to quarterly
This measure may be submitted by non-medical doctor/doctor of osteopathic medicine (MD/DO) Merit-based
Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based
on the services provided and the measure-specific denominator coding.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed
denominator criteria are used to identify the intended patient population. The numerator options included in this
specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not
need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for
submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B
claims data. For more information regarding Application Programming Interface (API), please refer to the Quality
Payment Program (QPP) website.

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One Final Consideration:
Measure #226: Preventive Care and Screening: Tobacco Use:
Screening and Cessation Intervention has undergone significant changes in recent years. If you select this measure for the
2020 PY, be sure you know the details of the measure.
n

Email mips@apma.org with questions or comments.

DENOMINATOR:
All patients aged 18 years and older with a diagnosis of diabetes mellitus
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Diagnosis for diabetes (ICD-10-CM): E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319,
E10.3211, E10.3212, E10.3213, E10.3219, E10.3291, E10.3292, E10.3293, E10.3299, E10.3311,
E10.3312, E10.3313, E10.3319, E10.3391, E10.3392, E10.3393, E10.3399, E10.3411, E10.3412,
E10.3413, E10.3419, E10.3491, E10.3492, E10.3493, E10.3499, E10.3511, E10.3512, E10.3513,
E10.3519, E10.3521, E10.3522, E10.3523, E10.3529, E10.3531, E10.3532, E10.3533, E10.3539,
E10.3551,
E10.3559, E10.3591,
Version 4.0E10.3541, E10.3542, E10.3543,
CPT E10.3549,
only copyright
2019E10.3552,
AmericanE10.3553,
Medical Association.
All rights reserved.
E10.3593, E10.3599, E10.37X1, E10.37X2, E10.37X3, E10.37X9, E10.36, E10.39, E10.40,
November E10.3592,
2019
Page 1 of 7
E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621,
E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01,
E11.10, E11.11, E11.21, E11.22, E11.29, E11.311, E11.319, E11.3211, E11.3212, E11.3213, E11.3219,
E11.3291, E11.3292, E11.3293, E11.3299, E11.3311, E11.3312, E11.3313, E11.3319, E11.3391,
E11.3392, E11.3393, E11.3399, E11.3411, E11.3412, E11.3413, E11.3419, E11.3491, E11.3492,
E11.3493, E11.3499, E11.3511, E11.3512, E11.3513, E11.3519, E11.3521, E11.3522, E11.3523,
E11.3529, E11.3531, E11.3532, E11.3533, E11.3539, E11.3541, E11.3542, E11.3543, E11.3549,
E11.3551, E11.3552, E11.3553, E11.3559, E11.3591, E11.3592, E11.3593, E11.3599, E11.37X1,
E11.37X2, E11.37X3, E11.37X9, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49,
E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638,
E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, E13.00, E13.01, E13.10, E13.11, E13.21, E13.22,
E13.29, E13.311, E13.319, E13.3211, E13.3212, E13.3213, E13.3219, E13.3291, E13.3292, E13.3293,
E13.3299, E13.3311, E13.3312, E13.3313, E13.3319, E13.3391, E13.3392, E13.3393, E13.3399,
E13.3411, E13.3412, E13.3413, E13.3419, E13.3491, E13.3492, E13.3493, E13.3499, E13.3511,
E13.3512, E13.3513, E13.3519, E13.3521, E13.3522, E13.3523, E13.3529, E13.3531, E13.3532,
E13.3533, E13.3539, E13.3541, E13.3542, E13.3543, E13.3549, E13.3551, E13.3552, E13.3553,
E13.3559, E13.3591, E13.3592, E13.3593, E13.3599, E13.37X1, E13.37X2, E13.37X3, E13.37X9, E13.36,
E13.39, E13.40, E13.41, E13.42, E13.43, E13.44, E13.49, E13.51, E13.52, E13.59, E13.610, E13.618,
E13.620, E13.621, E13.622, E13.628, E13.630, E13.638, E13.641, E13.649, E13.65, E13.69, E13.8, E13.9
AND
Patient encounter during the performance period (CPT): 11042, 11043, 11044, 11055, 11056, 11057,
11719, 11720, 11721, 11730, 11740, 97161, 97162, 97163, 97164, 97597, 97802, 97803, 99201,
99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309,
99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344,
99345, 99347, 99348, 99349, 99350
WITHOUT
Telehealth Modifier: GQ, GT, 95, POS 02
AND NOT
DENOMINATOR EXCLUSION:
Clinician documented that patient was not an eligible candidate for lower extremity neurological exam
measure, for example patient bilateral amputee; patient has condition that would not allow them to
accurately respond to a neurological exam (dementia, Alzheimer's, etc.); patient has previously documented
diabetic peripheral neuropathy with loss of protective sensation

B:11.5"
T:11.5"
S:11.5"

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Definition:
Lower Extremity Neurological Exam - Consists of a documented evaluation of motor and sensory abilities
and should include: 10-g monofilament plus testing any one of the following: vibration using 128-Hz tuning
fork, pinprick sensation, ankle reflexes, or vibration perception threshold; however, the clinician should
perform all necessary tests to make the proper evaluation.
NUMERATOR NOTE: To determine performance met, the lower extremity neurological exam could
be performed and documented on the date of the denominator eligible encounter or within the 12month lookback period from the date of the denominator eligible encounter.
Numerator Options:
Performance Met:
OR 4.0
Version
Not Met:
NovemberPerformance
2019

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Lower extremity neurological exam performed and
documented (G8404)

CPT only copyright 2019 American Medical Association. All rights reserved.
Lower extremity neurological exam not performed
Page 2 of 7

(G8405)

RATIONALE:
Foot ulceration is the most common single precursor to lower extremity amputations among persons with diabetes.
Treatment of infected foot wounds accounts for up to one-quarter of all inpatient hospital admissions for people with
diabetes in the United States. Peripheral sensory neuropathy in the absence of perceived trauma is the primary
factor leading to diabetic foot ulcerations. Approximately 45-60% of all diabetic ulcerations are purely neuropathic.
Other forms of neuropathy may also play a role in foot ulcerations. Motor neuropathy resulting in anterior crural
muscle atrophy or intrinsic muscle wasting can lead to foot deformities such as foot drop, equinus, and hammertoes.
In people with diabetes, 22.8% have foot problems such as amputations and numbness, compared with 10% of
nondiabetics. Over the age of 40 years old, 30% of people with diabetes have loss of sensation in their feet.
CLINICAL RECOMMENDATION STATEMENTS:
Recognizing important risk factors and making a logical, treatment-oriented assessment of the diabetic foot requires
a consistent and thorough diagnostic approach using a common language. Without such a method, the practitioner is
more likely to overlook vital information and to pay inordinate attention to less critical points in the evaluation. A
useful examination will involve identification of key risk factors and assignment into appropriate risk category. Only
then can an effective treatment plan be designed and implemented. (ACFAS/ACFAOM Clinical Practice Guidelines)
COPYRIGHT:
This measure is owned by the American Podiatric Medical Association (APMA), copyright 2019. CPT® contained in the
Measure specifications is copyright 2004-2019 American Medical Association. ICD-10 is copyright 2019 World Health
Organization. All Rights Reserved.

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APMA News March/April 2020
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T:21"

S:21"

NUMERATOR:
Patients who had a lower extremity neurological exam performed at least once within 12 months

B:21"

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Important Note:
If the patient does not meet the elements of the denominator (i.e., is not eligible for the measure), no action is needed. Do not make up an encounter code your visit does not
support. CMS will not be looking for your performance in
this instance because your patient does not meet the denominator criteria.
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